Surgical instrument



Jan. 30, 1934. Q RUSSELL 1,945,380

' SURGICAL INSTRUMENT Filed Feb. 4, 1931 INVENTOR M1950 rZzqaseZL BY w Patented Jan. 30, 1934 UNITED STATES PATENT OFFICE Application February 4, 1931.

11 Claims.

My present invention relates to optics and more particularly to the application thereof to surgical instruments, such as laryngoscopes for exploring the oral and nasal cavities and those of 5 the throat, trachea, bronchial tubes and esophagus. And it has for its object to provide an instrument of such character as will be simple in construction and effective and convenient in use. Some improvements are directed in part toward making it possible for the subject or patient to see his own vocal cords and interior larynx at the same time the physician does; toward provisions whereby a number of students, relatives of the subject or other persons in the room may make the same observations concomitantly therewith; toward concentrating or condensing the view from whatever point or angle entirely on the object or organ under observation; toward illuminating the object more brilliantly without the diffusion heretofore encountered; and toward eliminating the heat of the illuminant whereby irritation and inflammation is avoided even after hour-long examinations.

To these and other ends, the invention resides in certain improvements and combinations of parts, all as will be hereinafter more fully described, the novel features being pointed out in the claims at the end of the specification.

In the drawing:

Fig. 1 is a side elevation of an instrument of the character described constructed in accordance with and illustrating one embodiment of my invention;

Fig. 2 is a top plan View thereof;

Fig. 3 is a fragmentary bottom View of the collecting mirror and associated lighting device;

Fig. 4 is a vertical section on the line 4-4 of Fig. 1 looking in the direction of the arrow into the face of the reflecting mirror;

Fig. 5 is a fragmentary rear view looking into the window or lens with the reflecting mirror removed, and

Fig. 6 is a horizontal section taken on the line 6-6 of Fig. 1 with the cylindrical part shown partly in elevation and partly in section.

Similar reference numerals throughout the several views indicate the same parts.

A suitable name for my improved instrument is a fonofaryngoskop because of its increased capabilities as compared with the ordinary laryngoscope, but the general construction, purposes and manner of using the latter being well known in the art, I will, in this specification, first describe the construction of the present device without much reference to the various functions of Serial No. 513,371

the parts and follow it with an explanation of the mode of operation and the purposes of the various instrumentalities in detail. 1 1

Referring more particularly to the drawing, 1 indicates the main tube or barrel in the normal horizontal position of Figs. 1 and 2 rotatably supported in a ring-shaped head 2 carried on the upper end of a suitable shaft handle or other support 3. The front end of the tube is chamfered or cut at an angle of about 45 degrees to the axis, as indicated at 4, to accommodate a laryngoscopic or collecting mirror 5 at this minimum angle. This mirror collects the rays from an object below through an opening 6 in the under side of the tip of the tube. The mirror frame is mounted on a stifiiy frictional pivot '7 for ad-- justment to different set positions at wider angles. The said pivot is on the projecting end of a detachable arm shaving a snug fit sufficient to hold it in place in a scabbarded socket 9 fixed to the top of the tube 1, the removability being, ofcourse, for cleaning and sterilizing purposes.

Running along one side of the tube is a small tubular conduit 10, in which a lamp carrying stem 11 may be inserted or pulled out rearwardly therefrom. The electric lamp bulb 12 is carried at the forward end of this stem and the light, partially hooded and protected by the end of the conduit, issues through an opening 13 in the under side of the tip of the latter in a direction coincident with the line of incidence from the object to the face of the mirror 5. The rear end of the stem 11 is bent downwardly and to the left at an angle and carries a plug 14 with the terminal contact 15 of the usual insulated wire that runsthrough the stem to the lamp, the other terminal of the filament of the latter being grounded as usual. The socket of the usual cord connection is secured on the plug by a laterally projecting pin 16 and the plug carrying elbow forming the rear end of the stem is frictionally held in place and against rotation by a transverse pin 17 occupying a bore or socket in the spaced collars 18 on the tube 1 that engage the opposite sides of the head ring 2 and confine the tube to its bearing in the latter. The tube can be turned in this bearing to any desired position of adjustment to obtain a view in all directions in the plane of its rotations, as, for instance, in a reversed position to that of Figs. 1 and 2, and is held so adjusted by a set screw in the head ring 2, terminating in the thumb nut 19.

The angle of reflection from the collecting mirror 5 is rearwardly down the tube 1 to a window a clamping screw threaded through the collar" to hold the rod 23 in different positions oi adjustment resulting from the aforesaid movements.

A standard 26 is carried by the rod 23 inall of" 15 its movements and additionally it slides transversely therethrough and is held in difi'er'en't positions of adjustment by a knurledset' screw '27.-

At its outer end, it carries a knuckle 28 in which is pivoted at 29 a diaphragm frame30 carrying 2Q ;a -stage or reflecting mirror 3 1, the latter and-the ,iframe being provided with alined openings form ing a peep hole 32. r I {Ihewhole group oi parts just described allows theimirroriil aiuniversal adjustment with re 25 ;spectto itsrefiecting surface in a manner so ;'fObYlOL l$ that iurther 'description is' thought unnecessary Eurthermore, the peep hole 32 is .-similarlyadjustable with it as it must be main- -j tained intheaxis of the tube 1 and of the lens 3Q or window 20 to give a full field of vision. For

g instance; if the mirror is tilted back, to the dotted line-position A from the full line position of. Fig. 1, it will swing the peep hole below the axis and the stem 21 must be raised slightly to 35 restoreit. As to 'the general operation, the front end of the tubel is inserted in the patients mouth and if, for'instance, the vocal cords are the object of examination, the collecting mirror 5 is adjusted 4Q; toabout the position shown in Fig. 1 and'the image-thereon is observed by the surgeon or oper-atorlithrough the peep hole 32 and window'20, it making little difference for his purposes'alone "z rhow far 'backof: the window or eye 'pi'ece'the' dia- Qphragm 30 isadjusted' However, anobjec't of the invention is topermit the patient or subject to ,galsotake the same View at the same time, which he gains by observing the image on the collecti-ng mirror reflected in the stage mirror 31,"though is directionally' reversed through the double re-- d flection; For this purpose, the mirror 31 is moved back. from the eye piece and preferably tilted -.-sll'ght ly,;as indicated at A in dotted lines; in order i I that-the patients View will not belobscured by interve'ning parts,such as the head 2, but the angles of incidence andreflection are so great as be- ]tweenth'e axis of the tube and the line offsight -that the anglefof the reflecting mirror 31 need notbe great, but, in fact, a fair view of 'theimage may Ice-obtained by drawing it back to the dotted line position B without tilting.

Still another capability contributed by the universally' adjustable reflecting stage and also by its.

reinova'bility is to make of the instrument'not only I a viewing and examination apparatus f0l"f&lll30 inspection'purpose, but also for student-teacher j demonstration'purposes, or where it is desired,

this part can beslipped' out, thus permitting undisturbed simple laryngeal examination and op- 7i} erative procedures as employed by physicians and surgeons generally, because the removable feature of the eye piece carrying the lens or window 20.makes it, possible to use the fonofar'yngos kop..

j fo r inser tion of 1 surgical instruments through the 5 tube in normal operative procedure. The group of additional observers stand behind or to one side of the patient and the reflecting mirror is inclined in two planes relatively to the optical axis accordingly.

The objects of the invention as related in the introduction to this specification are thus accomplished and in addition, it is pointed out that the view through the tube makes it unnecessary to impede movement of" the tongue, epiglottis, et cet'era; to open the patients mouth as wide as is required in ordinary laryngoscopy, the fonofaryngoskop requiring as it does a space more the size of a marble instead of spreading the mouth to the diameter of a billiard ball, as is customary where the usual laryngeal mirror is employed,

' and it is further unnecessary with the use of my instrument-to depress the tongue, pull the tongue out, as is so often necessary in the usual laryngoscopy in order to counteract so-called retracted epiglottis (which I believe to be actually nonexistent) or prevent capping theview of the vocal cords'by the epiglottis. The application or force on the epi'glottis "as in direct laryngoscopyis also obviated.

' 'I' claimas my invention: I 1. In a surgical instrument of the characterdescribed, the con'ilzination "with a bodytube providedwith a collecting mirror at one end inclinedto the axis or the tube, and having anobservation opening at the other end, of a'h-ood onthetube" adjacent'to the mirror between the latter an d the observation openingandadapted to'contain a lamp from 'whichthe mirror isth'ereby shielded, the open side of the hood being arrangedtoconfine theillumination to a direc'tion coincident with the line of incidence from the'object't'dthe face of the mirror.

2. Infasurgical instrument of the characterdes'cribed', the combination with a body tube-having a longitudinally extending socket at one'end ex tending along the periphery, of. adetachablejstem frictionally' engaging within. the socket; and a collecting mirror having a pivotal connection" with thestemt'o move to differentangular-positions relatively to" the'axis otthejbody tube andremovable with the'stem.

3. In a surgical instrument of "the character described, the combination with abody tube provided with a collecting. mirrorat one'endinclined to the axis of the tube "and having -an observa 'ticn' opening at the other end, of a icasing'running longitudinally along one "side" ofthe tube and terminating in a hood adjacentto" the1--mirror and betweenithe'latter andtheobservation opening, said hoodhaving an opening arranged to confine the illumination'to a direction-coincident withv the line o'fiincidence from the object to the face of the mirror, and a detachable lamp stem in the casinghaving electrical -'con-nections.

4. In a surgical instrumentof the character described, the combination with'a body tube'provided with a collecting mirror at oneend inclined to the axis ofthe tube", supporting means near the opposite end of the latter embodying abearing ring in which the tuberotates, and spaced collars on the tube"cooperating-with-the' ring, of a casing running. longitudinallyalong'one side of the tubethrough the bearing collars and'termihating in a hood adjacent to the'rnirror','said hood having an opening arranged to confine the i1 lumination to a direction coincident with'theline of incidence from theobjecttoflthe' face o flthe mirror, and a detachable .lampstem inthe'casing having electrical connections on an end projectingf'rom thebearmg comers.

5. In a surgical instrument of the character described, the combination with a body tube provided with a collecting mirror at one end inclined to the axis of the tube and having an observation opening at the other end, of a support for the tube at its latter end, and a reflecting mirror on the support adjustable along the axis of the tube.

6. In a surgical instrument of the character described, the combination with a body tube provided with a collecting mirror at one end inclined to the axis of the tube and having an observation opening at the other end, of a support for the tube at its latter end, and a reflecting mirror on the support adjustable angularly relatively to the axis of the tube.

7. In a surgical instrument of the character described, the combination with a body tube provided with a collecting mirror at one end inclined to the axis of the tube and having an observation opening at the other end, of a support for the tube at its latter end, and a reflecting mirror on the support having a universal adjustment angularly and longitudinally relatively to the axis of the tube.

8. In a surgical instrument of the character described, the combination with a body tube provided with a collecting mirror at one end inclined to the axis of the tube and having an observation opening at the other end, of a support for the tube at its latter end, and an adjustable reflecting mirror on the support having a central peep opening therein.

9. In a surgical instrument of the character described, the combination with a body tube provided with a collecting mirror at one end inclined to the axis of the tube and having an observation opening at the other end, of a support for the tube at its latter end having a guide therein, a rod slidably and rotatably adjustable in the guide parallel to the axis of the tube, a stem slidably and rotatably adjustable on the rod transversely to the axis of the tube, and a reflecting mirror having a central peep opening pivoted on the stem.

10. In a surgical instrument of the character described, the combination with a body tube having a longitudinally extending socket at one end, of a detachable stem frictionally engaging within the socket, a collecting mirror having a pivotal connection with the stem to move to difierent angular positions relatively to the axis of the body tube and removable with the stem, the opposite end of the body tube being provided with an observation opening, and a detachable eye piece having a slip fit inset opening.

11. In a surgical instrument of the character described, the combination with a body tube provided with a collecting mirror at one end inclined to the axis of the tube, of supporting means near the opposite end of the latter embodying a handle having a bearing ring in which the tube rotates and spaced collars on the tube closely embracing the ring, and a detachable eye piece projecting from the face of one of the collars.

G. OSCAR RUSSELL. 

